NPIMap

Organization Active NPI

Mid State Endo Uap, LLC

  • Anesthesiology Physician
  • Murfreesboro, TN
National Provider Identifier
1710309265
Registry record updated Oct 26, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
Legal business name
MID STATE ENDO UAP, LLC
Practice address
1115 Dow St
Suite a
Murfreesboro, TN 37130-2487
Phone
(615) 848-9234
Fax
(615) 893-3188
NPI assigned
Jan 16, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 26, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Kristen Oconnor
Title
Officer/Authorized Official
Phone
(615) 376-7315

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207L00000X Primary
Certified Registered Nurse AnesthetistGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 367500000X

Addresses

Primary practice location

1115 Dow St
Suite a
Murfreesboro, TN 37130-2487

Mailing address

1115 Dow St Ste a
Murfreesboro, TN 37130-2487
Phone (615) 848-9234

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140616000835 TN Part B Supplier - Clinic/Group Practice 3577787431 Receives reassigned benefits from 12 practitioners
Practice locations: Murfreesboro, TN

National Provider Directory

National Provider Directory

Member of 4

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1389830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1666742400000",
    "number": "1710309265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1115 DOW ST STE A",
            "city": "MURFREESBORO",
            "state": "TN",
            "postal_code": "371302487",
            "telephone_number": "615-848-9234",
            "fax_number": "615-893-3188"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115 DOW ST",
            "address_2": "SUITE A",
            "city": "MURFREESBORO",
            "state": "TN",
            "postal_code": "371302487",
            "telephone_number": "615-848-9234",
            "fax_number": "615-893-3188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MID STATE ENDO UAP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-16",
        "last_updated": "2022-10-26",
        "certification_date": "2022-10-26",
        "status": "A",
        "authorized_official_last_name": "OCONNOR",
        "authorized_official_first_name": "KRISTEN",
        "authorized_official_title_or_position": "OFFICER/AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "615-376-7315"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "367500000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Murfreesboro, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.